Health Policy, Reform, and Innovation

Ontario’s Registered Practical Nurses are regulated health care professionals who work autonomously and in collaboration with other members of the health care team. Registered Practical Nurses now comprise more than 25 percent of Ontario’s total nursing workforce. Over 96 percent of Ontario’s RPNs are employed in direct practice positions caring for people at the bedside. Registered Practical Nurses are the largest group of nursing care provider in the Long Term Care sector and the fastest growing group in the Community Care sector, and the rates of employment of RPNs in these sectors are trending upwards from previous years. Today almost 18,000 RPNs employed in nursing in Ontario identify Seniors Care as their area of specialization. And as the needs of Ontario’s patients increase in complexity, RPNs are receiving more education to enable them to provide the highest quality care.

The demographic and fiscal challenges facing Ontario are unprecedented in our province’s history. Health care expenditures now account for over 40 percent of provincial program spending. Over the next 20 years, the number of seniors 65 years of age and older living in Ontario will double and the number of seniors over the age of 85 will quadruple. The aging of our population alone will increase our health costs by $24 billion – or 50 percent – by 2030 unless we transform our health care system to make it more effective and efficient.

The current system is too focused on providing episodic acute care and treating illness instead of promoting good health, preventing and managing disease, and addressing the socio-economic determinants of health. We believe that whenever possible, people should receive the care they need at home and in the community – where they want to receive care – rather than in hospitals and long-term care homes. If people have to go to the hospital, most want to get back home as soon as possible. And home care and community care happen to cost patients and taxpayers much less than care provided in hospitals and long-term care homes. The average cost of caring for a resident in his or her home is $42 per day, compared to $126 per day in a long-term care home and $842 per day in a hospital, according to the Ontario Home Care Association. Despite the higher costs of acute care, too many people are still forced to rely on hospitals – and especially on emergency departments – to get the care they need, instead of receiving optimal care at lower costs in their homes and communities. And too many people have to return to the hospital after being discharged because they did not receive the right follow up care in their homes.

The alternative to the current episodic acute care system is a more patient-focused system that treats the whole patient by providing care in the community in which the patient lives and works and by addressing the social and economic determinants that impact the patient’s health. Such a system would be embedded in an integrated community-based and patient-centred primary health care network focused on health education, wellness promotion, preventative care, mental health care, seniors care, and the management of chronic disease and disability. A stronger primary health care system that cares for people in their communities would result in timelier access and better patient health outcomes while alleviating the pressure on other parts of the health care system, such as hospital emergency rooms. This would free up beds and other resources in hospitals and long-term care homes and save money to invest elsewhere in the health care system.

More money and resources must be invested in the Community Care and Home Care sectors without cutting investments in the Acute Care and Long Term Care sectors – sectors which will be as important in the future as they are today – especially given Ontario’s expanding population, the escalating costs of health technologies, and the widening prevalence of people with complex health conditions. This more patient-centred system requires the leadership of interdisciplinary teams comprised of nurses and other health care professionals who are enabled to work to their full scopes of practice in order to achieve the highest quality patient care at the lowest possible cost to the system.

Ontario’s Registered Practical Nurses provide high quality health care to Ontario’s patients, residents, and clients. This is the reason that increasing numbers of RPNs are being employed in all health care sectors, but especially in the Community Care and Home Care sectors – the sectors in which a greater proportion of health care services should be delivered in order to ensure the most-efficient use of our health care resources. These are the sectors in which the health care of tomorrow will focus on promoting good health, preventing and managing disease, and addressing the socio-economic determinants of health, rather than on treating sickness at greater cost.

The highest quality and most cost-effective health care is achieved when patients receive timely access to the most appropriate care in the most appropriate place. And ensuring the right care, in the right place, and at the right time will become even more necessary as the shortage of nurses, especially the shortage of RNs, worsens over the next five years, eroding nurse-to-patient hours and undermining quality care and patient health outcomes while increasing the workloads of nurses, which will result in higher costs due to increases in sick time, absenteeism, overtime, and losses of nurses due to burn out.

Ontario’s health care system must be able to treat a wide array of patients with different health conditions, which means that our system needs a wide array of different health care professionals. We believe that patients deserve to benefit from a diversity of knowledge, expertise, and judgment and value the contributions made by Registered Nurses, Personal Support Workers (PSWs), and other health care professionals. This is the reason that RPNs are embracing the opportunity to work with other health care professionals to transform Ontario’s health care system. Everyone – from patients to doctors, front-line nurses to hospital administrators, PSWs to managers in the LHINs – has to work together if we are to achieve our common goal of transforming Ontario’s health care system to provide better quality care more efficiently. The people of Ontario deserve nothing less than our full commitment to making this happen.